Assessing Hand Hygiene Practices and Infectious Disease Outcomes in Preschools

A structured hand hygiene intervention targeting four key hand hygiene moments: 1. After toilet use 2. Before meals 3. After outdoor play 4. On arrival at preschool Each preschool transitions sequentially through these four intervention components in a stepped-wedge design over 12 months. The intervention includes: - Infrastructure support: provision of soap and alcohol-based hand rub (ABHR), installation of ABHR dispensers, and maintenance of functional handwashing stations. - Visual prompts: age-appropriate posters showing handwashing steps, brightly coloured reminder signs placed at sinks and classroom entrances. - Teacher modelling: educators demonstrating correct handwashing technique during routine transitions. - Teacher reminders: verbal cues such as “soap, wash, dry” before meals and after play. - Integration into daily routines: scheduled handwashing before group time, mealtimes, toileting routines, and after outdoor play. - Training: All preschool staff will receive a 2-hour face-to-face training session delivered by the research team 3 weeks prior to the intervention, covering correct technique, prompting methods, and recording procedures. - Adherence monitoring: direct observation by trained research assistants twice weekly and review of staff prompting checklists. Mode of delivery: Delivered face-to-face by preschool educators with support from research staff. Frequency / duration: Continuous implementation of each component for approximately 2.4 months per stepped-wedge period. Stepped-wedge description: All clusters begin in a baseline control period. Groups sequentially cross over to the intervention at different timepoints according to randomised allocation.